This issue is hotly debated now among Carriers. What do you do when an authorized doctor requires Claimant’s non-compensable condition be treated before the doctor will treat the compensable injury? For example, the authorized W/C surgeon will not perform surgery on the compensable back injury until a doctor clears Claimant’s cardiac condition.

Does the E/C have to authorize cardiac care for a non-compensable condition just so the doctor can treat a compensable lumbar condition?

There is always confusion about section 440.20(4), otherwise known as the 120 day rule. Per that statute, and E/C–if it is uncertain that a claim is compensable–can temporarily pick up the claim and with a good faith investigation determine if there is compensability.

This way, if the claim is compensable the injured worker does not miss his benefits. Yet, if there is evidence that the accident did not occur in the course and scope of employment or Claimant is not an employee or Claimant did not report the accident within 30 days, the E/C can still deny as long as it does so within the 120 days.

There is a notice requirement, in that the E/C must tell the Claimant, in writing, that is accepting compensability only for 120 days. Per the statute if the E/C does not deny the claim within 120 days then it waives its right to deny compensability.

But, does the E/C waive its right to deny the claim for any other reason? (more…)

Well, according to a new First DCA case, belly aching is fraud if Claimant does the belly aching to the Employer/Carrier’s IME. Be sure to print this one out as it is very favorable to E/C’s and will be useful when preparing your IME’s in the future.